1. Cytopathology of
Osteolytic Lesions in Bone
 Dr Genevieve Warner Learmonth
Cytopathologist/Histopathologist,
Cytopathology Laboratory, Groote Schuur Hospital
University of Cape Town

2. Lytic lesions in Bone
 Lytic lesions are easily aspirated using a
Jam Shedi needle.
 Most lytic lesions in bone are metastatic
tumours.
 However infectious lesions of bone due to
Tuberculosis and opportunistic infections
due to HIV/AIDS are becoming more
common in South Africa.
 Metabolic diseases can also present as lytic
lesions in bone

3. Bony lesion:
A sheperdess aged 60 years
from The Karoo, difficulty in
walking.
X Ray: knee joint destroyed.
Clinical Diagnosis:?Aneurysmal
Bone Cyst.
Jam Shedi needle aspirated clear

4. Clear Fluid with scanty translucent
hooklets and laminated membrane

5. Clinical Impression: Aneurysmal Bone
Cyst
 Note extensive involvement
of tibia, fibula, knee joint
space, patella and soft
tissues.
 No clinical signs of
inflammation
 No sinus formation
 No pain
 No clinical evidence of
parathyroid dysfunction.
 No renal disease

8. Histology of lytic lesion in
clavicle,cross section of scolex

10. Life cycle of Echinococcus
granulosus in South Africa

11. A wolf in sheep’s clothing

12. SIDEROSIS
 Mine Worker presented with massive
brawny oedema of lower limbs
 Clinically suspected of circulatory
prroblems, cardiac failure, thrombophlebitis
etc etc.
 After three weeks in hospital bed he
complained of backache.
 Xray of spine showed several collapsed
vertebrae, ? Osteoporosis, ?TB, ? myeloma

13. Jam Shedi needle aspirate of
vertebra for Cytology of fluid portion
and Histology of bony fragments

14. Haemosiderin laden
macrophages

15. Perls stain for Iron

16. Histology of Siderosis in Lytic
destroyed Bone

18. Masses of haemosiderin laden
macrophages

19. Attempt at bone repair,
creeping substitution and
endosteal fibrosis, osteoclastic
activity

20. Clinical features of
Siderosis
 Collapse of vertebral bodies “coin on
edge” lesion
 Adult scurvy –gingival hypertrophy
 Clinical stigma of Vitamin C deficiency
 Bleeding, anaemia, capillary
fragility, oedema of periphery – legs and
arms
 Destruction of weight bearing bones
 Iron deposition in liver, dysfunction of
liver

21. Clinical Outcome
 The Fine Strong Mine Worker
becomes
“A Man of Steel with Bones of Clay”

22. Tuberculosais in bone

23. 35 year old woman presents
with pain in lumbar area for
months, then sudden
paraplegia
 Xrays show lytic lesions in lumbar
vertebrae
 Jam Shedi needle aspirate yields
necrotic material.
 Cytology: Papanicolaou stain

25.  Drug-susceptible TB and MDR-TB are
spread the same way. TB germs are put
into the air when a person with TB
disease of the lungs or throat
coughs, sneezes, speaks, or sings.
These germs can float in the air for
several hours, depending on the
environment. Persons who breathe in
the air containing these TB germs can
become infected.

26. Necrotising Inflammation, no
evidence of granulomata

27. Rare Langhan’s cell

28. Ragged fragments of bone

30. TB bacilli, ZN stain and
autofluorescence with
Papanicolaou stain using LED

31. Histology ---Necrotising
inflammation. No granulomata.

32. TB and HIV ---the terrible twins

33.  Difficult to reach with health services